Thread by @karamballes

🧵Infection or Vaccination,
which is better for children?

What do the experts say?
Depends on which experts you ask

It comes to balance of harms, how are these harms being weighted?

Vaccine harm, short and long term, initial risk of covid infection, long covid, harms that manifest much later, risk of transmission, risk of mutation, length of immunity, degree of immunity against reinfection and future variants.

Are all being costed

US, Israel and others have already vaccinated millions of 11-17, other countries have yet to approve vaccination, and hundreds of millions of children live in countries which don't have enough vaccine supply that they won't be in a position to make this decision for some time

Personally I don't like the argument that we shouldn't offer children vax because other countries need them. We haven't exported any vaccines, and I don't think we are about to anytime soon even though most children aren't going to be offered the vax.

As things stand only Pfizer is approved by MHRA for 11-17 so there's nothing stopping us exporting AZ or J&J stock.
To address world shortages we need to ramp up production and release patents.
I know this will take a while but with talk of boosters, updates, future variants

It looks like the ability to produce future vaccines in vast quantities is the only way we would be able to provide the world an annual covid shot like flu which is what some believe will become the new normal.

A few months ago we were being told vaccines were going to solve it all on their own,looking at Israel pre Delta this might have been the case, but Delta is a game changer that we don't fully understand yet

Theres a realisation that the race between virus and vaccine has changed

There are also concerns that we simply don't have enough Pfizer supply to offer all children vaccination.

Whatever the reasons, the government is choosing not to invest in clean air in schools and choosing to remove mitigations.

https://twitter.com/karamballes/status/1413211423673569280?s=19

This isn't just withholding vaccination like some other countries, its accepting high levels of transmission.

After being told vaccines would solve everything, there has been a resurgence of talk about the benefits of natural immunity in younger age groups.

Well the course is set now, we are "going now" because "if not now then when"

Hybrid immunity is the strategy, and its a gamble.

Mass infection of younger age groups will "solve covid" according to GBD coauthor celebrating success in the UK

https://twitter.com/GYamey/status/1417316903744385025?s=19

This is how the CDC goes about balancing harms. Note that while lacking reference to long covid theyve com down on the vaccine side.

https://twitter.com/dgurdasani1/status/1417868591991492610?s=19

While MHRA have approved the vaccine, the JCVI have decided the balance of risks is currently in favour of vaccination for certain groups.

Good summary of JCVIs thinking

Oops forgot the post the link.

The JCVIs thinking

https://twitter.com/PaulNuki/status/1417556793014816768?s=19

One main difference is weighting of liklihood of myocarditis.
CDC and others who agree with them believe risk of myocarditis from vaccination is lower than covid risk.
JCVI haven't come down with opposite opinion, they want more data first.

The main issue those opposing the JCVI decision have is regarding the section covering Long Covid.

Working out the scale and severity of @LongCovidKids is one of the most heated debate topics at the moment, I imagine it will be a deciding factor for many

Just defining what long covid is creates disagreement
Dingwall in Newsnight said there was some cases of post viral syndrome but much of it is psychosomatic

Those who think its more than usual post viral syndrome considered this dismissal or denial.

https://twitter.com/hughes_eilir/status/1417255906748809233?s=19

For every view point there is a study, for every study there is an expert criticising the study, and emotions are high because the stakes are high if you think vaccination or infection is risky, children will face one or the other in high numbers, at the moment its infection.

Another question is how different is covid in children to adults.

What do we know about long covid in general, there is a lot of thought about how it interacts with immune system which gives rise to why there may be differences between children and adults

https://twitter.com/DaveLeeERMD/status/1413816137570205697?s=19

So much uncertainty, and with Delta its difficult to know how relevant older studies are now.

One of the most commonly cited studies at the moment as reassurance that we shouldn't worry about long covid in children is a Swiss study

https://twitter.com/RajeevJayadevan/status/1416313639686995968?s=19

Other evidence is data from the Zoe App and an Australian study.

Every study has its critics.

https://twitter.com/globalhlthtwit/status/1411795147243900928?s=19

And of course counter studies, which lead to the conclusion that perhaps we should stop worrying about long covid and start investing in mental health.

https://twitter.com/ShamezLadhani/status/1413990291355340800?s=19

Thread on the studies and evidence that leads others to believe that long covid is more than a low incidence post viral syndrome.

https://twitter.com/dgurdasani1/status/1417513507935948810?s=19

Every study has its critics.

One of the issues for people without a science background (including most the media) is that these scientific debates come down to mainly a matter of methodology and then interpretation.

Arguements against long covid being common are often based on how long covid symptoms are assigned in studies and data collection.

While studies saying its rare are often based on antibodies, this study is popular with those who agree with JCVI

https://twitter.com/ShamezLadhani/status/1417765913198223366?s=19

One thing that I found interesting was the return of talk of T-Cells providing natural immunity prior to contact with the virus. Something we heard a lot of last year but hadn't heard this for a while.

But every study has its critics

I remember last year we were told that T-Cells would provide natural immunity, and combined with prior infection we might already have herd immunity which means there wouldn't be a second wave

Some of the loudest voices on this did a lot of deleting

https://twitter.com/ConcernedofBri1/status/1417553757697712139?s=19

Can understand why so many people are confused and its further complicated by the fact that covid policies are political decisions made by politicians.

Most of last year the main debate was how easily are children infected and how infectious are they.

Official gov documents like the Green book still have the official gov line that children are less likely yo be infected and are unlikely to be drivers of infection.

There are plenty of voices that still agree with this

So for a lot of us it comes down to trust, and due to how emotive the debate is tribalism then kicks in, which does play into the hands of professional disinformation networks which seek to sow division through confusion.

I don't trust those who signed GBD letters, for a start the claims we already had herd immunity and could have gone without a lockdown when Alpha wave hit.

I also don't trust Viner anymore.

My reasoning is that he argued against masks being introduced saying they would be ineffective, he made the same arguments to support them being removed, then went on BBC and claimed masks and social distancing were part of a system of controls that were preventing transmission

He also said we had improved ventilation, this is a phrase I have heard repeatedly.

He knew masks had been removed, that there has been no investment in ventilation and that we didn't have social distancing.

https://twitter.com/karamballes/status/1400816314374148101?s=19

What we've ended up is with is two groups.
Those who believe transmission and now Long Covid is an issue, who want masks, ventilation and vaccination choice, critics label them scaremongering, zero covid fanatics, politically motivated.

Couple of months ago they were also accused by some of undermining the vaccine programme by pointing out that vaccine effectiveness would still result in significant breakthroughs and the need to maintain and improve mitigations for now

Then you have those who believe transmission isn't an issue in education settings, and long covid is a rare condition in children that masks or vaccines cause more harm to children than covid.

Both sides have their studies and criticisms of the others studies

The GBD are a subset who I can't see as honest participants for various reasons.

The others aren't a homogeneous group, they regularly make good contributions across the wider pandemic debate, I find myself agreeing with them on various topics.

Many of this group are labelled Covid Centrist, although I think I've generally seen it used as an insult than a self description.

On schools they generally say ventilation would be a good idea but seem to think we can make do with it whenever gov removes or fails to introduce

measures.
They weigh up the balance of harms and generally conclude the gov has got it right, on return dates without rotas, on removing masks, on not offering vaccination.

Yes ventilation would be good, but oh well.

Main issue I have with many of these is denial of the reality faced by front line workers

Most education workers are sick of hearing
"Schools have adequate control of measures, transmission is occuring outside of school"🤨
"Improved ventilation"🤔
"Social distancing" 🤣

These are the kind of exchanges when you say "we have no safety measures in schools"

At this time majority of Primary schools only had bubbles and handwashing.

Secondary, masks in corridors and LFT.

Ventilation is always great but its never the right time, notice the date, couple of weeks before classrooms close for for 5/6 weeks.
Often the option of simple portable box/units are ignored.

"If not now then when?"
Infection: now
Ventilation: later/never

#edutwitter Did the last week feel like "some cases"?
Parents, been having a lot of indoor meet ups and sleepovers lately?

Couldn't be schools we have all the measures we need.

We all know that children are considerably safer from sever illness and death, low but not zero

But pushing the stats lower by taking deaths and dividing by total number of children rather than by number infected does seem a bit silly.

I thought it was roughly estimated that 500k children have been infected. Although we are told we can't trust the ONS data when it comes to children infection, long covid, index cases etc

How many children have conditions that would class them as high risk?

Just these?

Child hospitalisations are rising, numbers are low, we don't know how high they will go now or in autumn term

Its lower than other age groups, but concerns around this are scaremongering, were told drawing attention to this will panic parents and children, there is truth in this

Back to with or from, but perhaps he has a point its only 40 a day

Except... 100 a week of RSV is worth tweeting about.

What really worries me about debate over JCVI decision besides long covid is impact it could have on vaccine programmes,here and policy abroad

Few months ago those saying a half complete vax programme wouldnt be enough without maintaining measures were labeled as aiding anti vax

AntiVaxers strongest argument is no data on long term effects.

We need to be open about this, and balances for adults might be diff from children but to tone police people, accuse them of scaremongering for wanting masks on schools and then use this choice of language?

Helpful?

Over the past month I'm hearing more vax hesitancy in 18-40, vaccine programme is slowing, antivaxers are having a field day over the child vax debate.

If its not safe for teens they argue why is it safe for anyone who is healthy?

Antivaxers are also aided by reintroduction of the benefits of natural immunity by infection introduced to the schools debate

As vaccine supply issues are raised, as Gov decides "go now" due to the "firebreak", then back to normal in Sept, natural immunity comes back

I don't know, spend a year being attacked for saying the gov is happy for transmission to spread through schools, and now its baked into gov modelling its no longer scaremongering its the sensible thing to do because of Tcells and vaccine harms and long covid being a rarity.

Like everyone else I've had to come to my own conclusions about the science, I do read everything from both sides and listen to the arguments, I do sometimes make mistakes, sometimes my frustration bubbles over into impoliteness, but I haven't the agenda some accuse me of

I wish the evidence convinced me of low transmission, of long covid being rare, of the power of natural immunity, the evidence on the other side is more convincing

I'd love to focus my efforts entirely on funding, pay and conditions but that's not what we see everyday in work.

Threads like this always generate abuse and criticisms (some will be fair)

For the trolls, no i don't want mandatory vaccination, and vaccine passport announcement was counterproductive in my opinion.

It its impacting public debate and behaviour

https://twitter.com/karamballes/status/1417241740172484610?s=19

I hope they are right about long covid, I hope their calculation of the risk posed by Delta is right, that infection is a better strategy than vaccination

Never wanted to be proved wrong as much as I do now, in 6 months time I'd love to say I was wrong.

https://twitter.com/erlichya/status/1417500150491197445?s=19

And we do have a supply issue.
If it turns out the JCVI decision was influenced by this...

https://twitter.com/jonworth/status/1418267414052098049?s=19